In 2011, Dr. Ken Murray, a clinical assistant professor of family medicine at the University of California, wrote an essay on end-of-life issues that went viral. Titled "How Doctors Die", Murray stated that compared to the rest of Americans, physicians didn't use heroic methods to prolong their lives. "For all the time they spend fending off the deaths of others, they tend to be fairly serene when faced with death themselves. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care they could want. But they go gently," Murray wrote.
In a follow-up article, he cited as proof a mid-century Johns Hopkins study which said that 65 percent of doctors surveyed had created advanced directives (instructions for what to do in end-of-life situations) while only 20 percent of the public had them. And 90 percent of the doctors in the study said they would not want CPR if they were in a coma, compared with 25 percent of the public.
The articles struck a chord with many readers who felt that they too would rather die at home, surrounded by loved ones, instead of hooked up to tubes in a hospital. But is the premise really true — that doctors use fewer interventions at end of life?
Researchers at the University of Colorado (CU) Anschutz Medical Campus say no. They found that 66.6 percent of doctors stayed in hospitals in the last six months of life versus 69.5 percent of non-doctors. Both groups spent around 18 days in hospital and about 25 percent of people in each group died there. Thirty-four percent in each group stayed in intensive care in the last six months of life. However, there was a slight difference in hospice care. Physicians stayed in hospice about two days longer than non-physicians.
"The overall narrative that doctors die differently is false," says the study's senior author Stacy Fischer, M.D., an associate professor at the CU School of Medicine in a press release.
The study authors looked at the deaths of nearly 10,000 physicians and about 192,000 non-physicians selected at random from Medicare participants, between July 2008 and December 2010.
As to why this new research conflicted with earlier data, study co-author Daniel Matlock, M.D., M.P.H. of CU Anschutz says that many of the earlier doctors practiced medicine in a time before widespread palliative care and numerous advances in intensive care. Also, "fear and avoidance of dying are strong motivators of much of human behavior and perhaps physicians are not immune to these fears of dying," he notes in a release.
The researchers wrote in their study that the fee-for-service Medicare reimbursement structure provides incentives for medical procedures but "little to no coverage for the supportive services patients and families commonly need to provide high-quality care outside of the hospital. Thus, the system has evolved to favor hospital-based interventions that may offer less value during a person's final months."
Adds Fisher, "We need to take a critical look at our health care system and ask what is driving this low value care and by that I mean care that doesn't offer any real quantity or quality of life. And clearly, despite their medical knowledge, physicians are not immune. We hope our study will help spark a national conversation about this increasingly important issue."